What happened when I tried a new memory-boosting therapy for bipolar

The prevalence of low mood in people diagnosed with depression or bipolar disorder is well trodden ground in discussions of mental illness – and rightly so. But cognitive factors, such as memory or concentration problems are often just as distressing for patients but are rarely discussed.

Reduced cognitive capacity can manifest in numerous debilitating ways: an inability to concentrate, poor memory, lack of inhibitory control, or trouble with problem solving, decision making or task management can all affect home life, relationships and work, as well as a person's sense of self or self-confidence. This can make it even more difficult to achieve what is already a fairly challenging sense of stability.

A meaningful change

Addressing these cognitive factors could result in what researcher Dimos Tsapekos calls "a meaningful change in everyday life" for those with mental health problems.

Tsapekos is part of a group of researchers at the Institute of Psychiatry, Psychology and Neuroscience at King's College, London looking into the benefits of cognitive remediation therapy (CRT) for bipolar. Unlike therapies like CBT, which seek to improve symptoms themselves, CRT targets baseline thinking skills, and is an attempt to "help the patient develop a new approach to thinking about, and in, their everyday lives".

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Preliminary research had suggested CRT could provide the same proven benefits for people with bipolar as it had for those with diagnosed schizophrenia – benefits that include mood improvement and meeting goals more easily. Now, the team are undertaking a pilot trial to test its feasibility for those with other mood disorders.

Therapy takes place over 40 sessions, and should be undertaken at least 3 days a week. Five to ten tasks are undertaken over the course of an hour session, and patients can carry out their work on or offline.

Some CRT tasks are 'cold' – meaning they're abstract and not directly based on real life situations – and others are 'hot', imitating daily life activities. A 'cold' task could involve a number game; a hot task would involve planning a day or organising a shopping trip.

"Some of the programme is task focused, and some of it is more about discussing strategies and how to apply them to daily life," Taspekos explains.

What happened when I tried it

When I tried the programme myself, for example, the tasks were fairly diverse – in one, I selected tasks that had to be completed within a day and was asked to order them according to a set of rules; in another, I was given information about where to get off a train and was prompted to press a button when I thought I was at the correct station. In another, more abstract, task, I was asked to find the quickest way through a maze.

The programme itself, CIRCUITS, is laid out like a virtual village, with buildings including a supermarket, library college, factory and more. Patients completing the tasks take a 'journey' through the village, practicing different skills as they go. This can help patients "concentrate, remember, be more organised, make plans, understand environments..." Taspekos says.

The goal of CRT isn't just the completion of tasks, though – researcher Becci Strawbridge told me that it's an attempt to teach patients how to use cognitive strategies to compensate for difficulties arising from mental illness. A key part of the programme is goal setting: patients are encouraged to set goals throughout and update them according to their progress.

Thinking about thinking

Patients are also encouraged to consider 'metacognition' – their awareness of thought processes, or their "thinking about thinking". If patients have trouble with memory, for example, they're encouraged to consciously consider strategies that can mitigate this: making lists or writing things down, for example. The systematic monitoring of goals – working out what works and what doesn't – can also lead to an increased self-awareness. Patients are also asked to rate expected difficulty before a task starts, and then reappraise once completed.

As the programme is only partly face to face, patients are also able to practice at home, which researchers say helps with applying the strategies in an appropriate, goal-focused way. The approach is referred to as 'scaffolding', Taspekos says – giving patients tools and strategies to cope, supporting them as they learn these strategies and then slowly taking the 'scaffolding' away, leaving people with the ability to make their own choices.

What do other experts think?

Other experts are cautiously hopeful about CRT – but are not without their concerns.

"It seems quite effective in this particular area and there is some evidence that the improvements are then generalised to other areas due to better motivation and increased flexibility eg "if I can improve and change one thing then I may be able to change other aspects of my life"," Dr Alison Jenaway, a member of the Faculty of Medical Psychotherapy at the Royal College of Psychiatrists, and consultant psychiatrist in Psychotherapy told me.

"But I am less convinced about this generalisation effect in patients with chronic, long-term problems."

"And the main problem in the health service at the moment is not the lack of effective therapies, it is the lack of any therapy for people with chronic mental health problems due to lack of resources and lack of psychologists and other highly trained therapists."

"If this therapy is very easy to learn and to train in, then it may have something to add because perhaps it will need less resources to make it available. But most people with chronic mental health problems have complex needs, with many factors making recovery difficult – social problems, poverty, stigma, relationship breakdown etc. This is likely to tackle only one area and may not be powerful enough to effect change in the real lives of people who are not able to take part in a research project."

What next?

Trials are also going on to test the efficacy of CRT on other disorders including anorexia, and trials involving medication including vortioxetine, lithium and doping drug EPO could also prove useful when tackling cognitive elements of mental illness – so for those of us tired of forgetting things or not being able to concentrate, there's hope yet.

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